Alcohol Abuse Changes the Brain
No one knows when alcohol was first produced. If any watery mixture of vegetable sugars or starches is allowed to stand long enough in a warm temperature, alcohol will make itself. Nature alone cannot produce anything stronger than 14% alcohol, but by distillation, the percentage can be increased to 93% (Kinney & Leaton, 1987).
Alcohol is the most used and abused psychoactive chemical in the United States. Approximately half of Americans have had a drink during the past 30 days, and 20% had five or more drinks on one occasion during the past 30 days. About 90% of children use before they leave high school, and 20% have consumed more than five drinks on one occasion during the past 30 days (U.S. Department of Health and Human Services, 1999). It is estimated that alcoholism costs Americans nearly $100 billion and results in 100,000 deaths per year (National Institute on Alcohol Abuse and Alcoholism, 1993, 1997).
The early detection of alcohol abuse and dependency is complicated by denial that is found in the individual, in the family, and in society. Long-term alcohol dependence has profound effects on personality, mood, cognitive functioning, and a variety of physiological problems involving virtually all organ systems. The interaction of alcohol and other drugs may lead to fatal overdoses (Frances & Franklin, 1988).
Alcoholism is the result of a complex interaction of biological vulnerability and environmental factors. Environmental factors such as childhood experience, parental attitudes, social policies, and culture strongly affect the vulnerability to alcoholism. Genetic variables significantly influence the disease. There probably is no personality style that is predictive of alcoholism (Goodwin, 1985; Vaillant, 1984).
Alcohol-Induced Organic Mental Disorders
Alcohol intoxication is the most frequent organic-induced mental disorder. It is time limited, and it may occur with varying amounts of ingested alcohol. The intoxicated individual exhibits maladaptive behavioral changes due to recent ingestion. These changes may include aggressiveness, impaired judgment, impaired attention, irritability, euphoria, depression, emotional liability, and other manifestations of impaired social functioning. Although alcohol is basically a CNS depressant, its initial effects disinhibit the individual. Early in intoxication, the person may feel stimulated with an exaggerated sense of well-being. With further use, the person may slow down and become depressed, withdrawn, and dull. The person may even lose consciousness (Spitzer, 1987; Woodward, 1994).
Alcohol Amnestic Disorder (blackout)
Alcohol amnestic disorder, or a blackout, is a period of amnesia during periods of intoxication. The person may seem fully conscious and normal when observed by others, but the person is unable to remember what happened or what he or she did while intoxicated. The disorder may last for a few seconds or for days. The severity and duration of alcoholism correlate with the frequency of occurrence of these blackouts (Goodwin, 1971; Goodwin, Crane, & Guze, 1969).
Wernicke-Korsakoff syndrome is a neurological emergency that should be treated by the immediate parenteral administration of thiamine. The symptoms begin with a sudden change in organic functioning. The patient becomes ataxic with a wide-based unsteady gait. The person may be unable to walk without support. The patient is mentally confused and unable to transfer memory from short- to long-term memory. The patient may be disoriented, listless, inattentive, and indifferent to the environment. Questions directed at the patient may go unanswered, or he or she may fall asleep while being examined. The etiology of this syndrome involves a thiamine deficiency due to dietary, genetic, or medical factors. All patients with compromised mental functioning or a deficit in memory need to be examined by the medical staff as soon as possible to prevent further brain damage (Braunwald et al., 1987).
Alcoholic Idiosyncratic Intoxication
Alcoholic idiosyncratic intoxication is a marked behavior change, usually to aggressiveness, due to recent ingestion of small amounts of alcohol. There usually is amnesia for the period of intoxication. The behavior is unusual for the person when he or she is not drinking. With one drink, the person may become belligerent or assaultive or may manifest other unusual behavior (Spitzer, 1987).
Alcohol withdrawal symptoms relate to a relative drop in alcohol blood levels. Withdrawal can occur when the individual is still drinking. The classic withdrawal symptom is a coarse fast frequency tremor observed when the patient’s hand or tongue is extended. The tremor is made worse by motor activity or stress. The patient may experience nausea and vomiting, malaise, weakness, elevated pulse and blood pressure, anxiety, craving, depressed mood, irritability, transient hallucinations, headache, and insomnia. These symptoms follow several hours after cessation or reduction in alcohol intake and peak within 72 hours. They almost always disappear within 5 to 7 days of abstinence. The patient in alcohol withdrawal is treated with a cross-tolerant drug similar in pharmacological effects to alcohol, usually one of the benzodiazepines. This stabilizes the patient in a mild withdrawal syndrome (Mayo-Smith, 1998; Schuckit, 1984).
Alcohol Withdrawal Seizures
Withdrawal seizures may occur 7 to 38 hours after the last alcohol use in chronic drinkers. The tendency to seizure peaks within 24 hours (Adams & Victor, 1981; Mayo-Smith, 1998).
Alcohol Withdrawal Delirium (delirium tremens)
One third of patients with seizures go on to develop alcohol withdrawal delirium or delerium tremens. This is characterized by confusion, disorientation, fluctuating or clouded sensorium, and perceptual disturbances (Adams & Victor, 1981; Mayo-Smith, 1998). Typical symptoms include delusions, vivid hallucinations, agitation, insomnia, mild fever, and marked autonomic arousal. The patient frequently reports visual hallucinations of insects, small animals, and other perceptual disturbances. The patient may be terrified. The delirium typically subsides after a few days, but it can continue for weeks (Gessner, 1979).
Alcohol Abuse: Craving
Twenty Questions About Alcohol Abuse
Chemical Dependency Counseling: A Practical Guide, Fifth Edition: is a best-selling comprehensive guide for counselors and front-line professionals who work with the chemically dependent and addicted in a variety of treatment settings. The text shows the counselor how to use the best evidence-based treatments available, including motivational enhancement, cognitive behavioral therapy, skills training, medication and 12 step facilitation. Guiding the counselor step-by-step through treatment, this volume presents state-of-the-art tools, and forms and tests necessary to deliver outstanding treatment and to meet the highest standards demanded by accrediting bodies.
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Alcoholics are one of the most difficult client groups to treat effectively. To preserve their way of life, they may lie about their problem or deny that one exists; that is the nature of this profoundly powerful disease. Yet if you can guide each of your clients through their own resistance towards the truth, not only will you be rewarded with starting them on the road to recovery, you will no doubt have saved their life as well. Achieving such a victory goes to the heart of being an addiction counselor; it is the experience of healing on a direct and tangible level.
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